Burvill Angela J, Murray Kevin, Knuiman Matthew W, Hung Joseph
Medical School, University of Western Australia, Crawley, WA, Australia.
School of Population and Global Health, University of Western Australia, Crawley, WA, Australia.
Clin Hypertens. 2022 Jun 1;28(1):16. doi: 10.1186/s40885-022-00199-1.
Population health behaviour and risk factor surveys most often rely on self-report but there is a lack of studies assessing the validity of self-report using Australian data. This study investigates the sensitivity, specificity and agreement of self-reported hypertension and hypercholesterolaemia with objective measures at standard and more stringent diagnostic thresholds; and factors associated with sensitivity and specificity of self-report at different thresholds.
This study was a secondary analysis of a representative community-based cross-sectional sample of 5,092 adults, aged 45-69 years, residing in Busselton, Western Australia, surveyed in 2010-2015. Participants completed a self-administered questionnaire. Blood pressure and serum cholesterol levels were measured.
At currently accepted diagnostic thresholds, sensitivities of self-reported hypertension and hypercholesterolaemia were 58.5% and 39.6%, respectively and specificities were >90% for both. Agreement using Cohen's kappa coefficient was 0.562 and 0.223, respectively. At two higher diagnostic thresholds, sensitivities of self-reported hypertension and hypercholesterolaemia improved by an absolute 14-23% and 15-25%, respectively and specificities remained >85%. Agreement was substantial for hypertension (kappa = 0.682-0.717) and moderate for hypercholesterolaemia (kappa = 0.458-0.533). Variables that were independently associated with higher sensitivity and lower specificity of self-report were largely consistent across thresholds and included increasing age, body mass index, worse self-rated health, diabetes and family history of hypertension.
Self-reported hypertension and hypercholesterolaemia often misclassify individuals' objective status and underestimate objective prevalences, at standard diagnostic thresholds, which has implications for surveillance studies that rely on self-reported data. Self-reports of hypertension, however, may be reasonable indicators of those with blood pressures ≥160/100 mmHg or those taking anti-hypertensive medications. Self-reported hypercholesterolaemia data should be used with caution at all thresholds.
人群健康行为和风险因素调查大多依赖自我报告,但缺乏使用澳大利亚数据评估自我报告有效性的研究。本研究调查了在标准诊断阈值和更严格诊断阈值下,自我报告的高血压和高胆固醇血症与客观测量结果相比的敏感性、特异性和一致性;以及不同阈值下与自我报告敏感性和特异性相关的因素。
本研究是对2010 - 2015年在西澳大利亚州巴瑟尔顿市对5092名年龄在45 - 69岁的成年人进行的具有代表性的社区横断面样本进行的二次分析。参与者完成了一份自填式问卷。测量了血压和血清胆固醇水平。
在目前公认的诊断阈值下,自我报告的高血压和高胆固醇血症的敏感性分别为58.5%和39.6%,两者的特异性均>90%。使用科恩kappa系数的一致性分别为0.562和0.223。在两个更高的诊断阈值下,自我报告的高血压和高胆固醇血症的敏感性分别绝对提高了14 - 23%和15 - 25%,特异性仍>85%。高血压的一致性较高(kappa = 0.682 - 0.717),高胆固醇血症的一致性中等(kappa = 0.458 - 0.533)。与自我报告较高敏感性和较低特异性独立相关的变量在不同阈值下基本一致,包括年龄增加、体重指数、自我健康评价较差、糖尿病和高血压家族史。
在标准诊断阈值下,自我报告的高血压和高胆固醇血症常常对个体的客观状况进行错误分类,并低估客观患病率,这对依赖自我报告数据的监测研究具有影响。然而,高血压的自我报告可能是血压≥160/100 mmHg或正在服用抗高血压药物者的合理指标。在所有阈值下,自我报告的高胆固醇血症数据都应谨慎使用。